High potency benzodiazepines are effective anti-panic agents that are frequently prescribed for panic disorder. Recent FDA indications for panic disorder of alprazolam and subsequent company marketing should increase prescription frequency. However, difficulties with discontinuation have made this class of drugs controversial and, along with negative side effect profiles, have led to proposals for additional regulatory actions. Inability to discontinue benzodiazepine treatment exposes the patient to persisting drug associated adverse effects for a longer period of time and also does not allow the clinician to assess if the disorder has remitted. Although discontinuation is desirable for these reasons, no well studied effective discontinuation procedures yet exist. We propose to study the efficacy of a psychosocial program for the acute discontinuation of both short half life (alprazolam) and long half life (clonazepam) high potency benzodiazepine treatment of panic disorder. Successful discontinuation in the acute period and long-term maintenance of discontinuation will be examined after treatment with an adaptation of the Albany panic control treatment (PCT) adapted to facilitate benzodiazepine discontinuation (PCT-BD) combined with a conservative taper as usual (TAU) protocol. This program will be compared to a supportive group treatment that engages and educates the patient in a manner similar to PCT-BD, but without the specific therapeutic procedures, combined with TAU, and the TAU protocol alone. Pending further evaluations, the results may suggest an optimal way to combine high potency benzodiazepine treatment and PCT; that is, initial treatment with benzodiazepines could be followed by a course of PCT specifically designed to assist in discontinuation and prevent relapse. In addition, this study has the potential of providing important information on newer elements of treatment (e. g., interoceptive exposure) that may be important for maximizing the ability of patients to tolerate uncomfortable withdrawal effects, thereby maximizing the effectiveness of drug discontinuation efforts.
